Abstract
Background: There are two approaches to close gastroschisis. Primary closure (PC) is reduction and fascial closure; silo closure (SC) places viscera in a preformed-silo and reduces the contents over time. We have shifted from PC to SC. This study compared the outcomes of these two techniques.
Methods: Records of babies with gastroschisis from 1994–2004 were reviewed. Closure type, ventilator days, days to full-feeds, hospital days, complications, and mortality were recorded.
Results: Twenty-eight patients underwent PC; 20 patients had SC. Differences in ventilator days, days to full-feeds, and hospital days were not statistically significant. Nine PC patients developed closure-related complications vs. none in SC (P<0.05). Eight PC vs. two SC patients had non-closure-related complications (P<0.05). Four PC vs. zero SC patients developed necrotizing enterocolitis (P<0.05). Five PC vs. one SC patients had ventral hernia (P<0.05). No patient died.
Conclusion: PC resulted in higher incidence of reclosure, non-closure-related complications, and necrotizing enterocolitis. Consequently, we recommend SC as the preferred treatment.
References
1 Allen RG, EL Wrenn: Silon as a sac in the treatment of omphalocele and gastroschisis. J Pediatr Surg4 (1969) 3Search in Google Scholar
2 Buchanon RW, WL Cain: A case of complete omphalocele. Ann Surg143 (1943) 552Search in Google Scholar
3 Calder J: Two examples of children with preternatural formation of the guts. In: Medical Essay and Observations. Edinburgh 1733Search in Google Scholar
4 Canty TG, DL Collins: Primary fascial closure in infants with gastroschisis and omphalocele: a superior approach. J Pediatr Surg18 (1983) 707Search in Google Scholar
5 Driver CP, J Bruce, A Bianchi, CM Doig, AP Dickson, J Bowen: The contemporary outcome of gastroschisis. J Pediatr Surg35 (2000) 1719Search in Google Scholar
6 Ein SH, SZ Rubin: Gastroschisis: primary closure or Silon pouch. J Pediatr Surg15 (1980) 549Search in Google Scholar
7 Fear W. Br Med J2 (1878) 518Search in Google Scholar
8 Filston HC: Gastroschisis – primary fascial closure. The goal for optimal management. Ann Surg197 (1983) 26010.1097/00000658-198303000-00003Search in Google Scholar
9 Fischer JD, K Chun, DC Moores, HG Andrews: Gastroschisis: a simple technique for staged silo closure. J Pediatr Surg30 (1995) 1169Search in Google Scholar
10 Fonkalsrud EW, MD Smith, KS Shaw, JM Borick, A Shaw: Selective management of gastroschisis according to the degree of visceroabdominal disproportion. Ann Surg218 (1993) 742Search in Google Scholar
11 Izant RJ, F Brown, BF Rothman: Current embryology and treatment of gastroschisis and omphalocele. Arch Surg93 (1966) 49Search in Google Scholar
12 Kidd JN Jr, RJ Jackson, SD Smith, CW Wagner: Evolution of staged versus primary closure of gastroschisis. Ann Surg237 (2003) 759Search in Google Scholar
13 Klein MD: Congenital abdominal wall defects. In: Ashcraft KW, GW Holcomb III, JP Murphy: Pediatric Surgery, 4th ed. Elsevier, Philadelphia 2005Search in Google Scholar
14 Kleinhaus S, N Kaufer, SJ Boley: Partial hepatectomy in omphalocele. Surgery64 (1981) 484Search in Google Scholar
15 Kron IL, PK Harman, SP Nolan: The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg199 (1984) 28Search in Google Scholar
16 Meltzer A: Huge omphalocele ruptured in utero. J Am Med Assoc160 (1956) 656Search in Google Scholar
17 Minkes RK, JC Langer, MV Mazziotti, MA Skinner, RP Foglia: Routine insertion of a Silastic spring-loaded silo for infants with gastroschisis. J Pediatr Surg35 (2000) 843Search in Google Scholar
18 Moore TC, GE Stokes: Gastroschisis. Surgery33 (1953) 112Search in Google Scholar
19 Raffensberger JG, JZ Johan: Gastroschisis. Surg Gynecol Obstet138 (1974) 230Search in Google Scholar
20 Richards WO, W Scovill, B Shin: Acute renal failure associated with increased abdominal pressure. Ann Surg197 (1983) 183Search in Google Scholar
21 Schuster SR: A new method for the staged repair of large omphaloceles. Surg Gynecol Obstet125 (1967) 837Search in Google Scholar
22 Stringel G: Large gastroschisis: primary repair with Gore-Tex patch. J Pediatr Surg28 (1993) 65310.1016/0022-3468(93)90023-ESearch in Google Scholar
23 Watkins DE: Gastroschisis. Va Med70 (1943) 42Search in Google Scholar
24 Wesley JR, R Drongowski, AG Coran: Intragastric pressure measurement: a guide for reduction and closure of the silastic chimney in omphalocele and gastroschisis. J Pediatr Surg16 (1981) 264Search in Google Scholar
25 Yaster M, TL Scherer, MM Stone, LG Maxwell, CL Schleien, RC Wetzel, et al.: Prediction of successful primary closure of congenital abdominal wall defects using intraoperative measurements. J Pediatr Surg24 (1989) 1217Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York